|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 31722-597-30
|
| Hospital Charge Code |
1712621
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.89
|
| Rate for Payer: Blue Distinction Transplant |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Media |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Riverside University Health System MISP |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 31722-597-30
|
| Hospital Charge Code |
1712621
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Blue Shield of California Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California EPN |
$1.71
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
RITONAVIR 80 MG/ML ORAL SOLUTION [16440]
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
NDC 0074-1940-63
|
| Hospital Charge Code |
1715199
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Blue Shield of California Commercial |
$5.40
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$4.68
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
|
|
RITONAVIR 80 MG/ML ORAL SOLUTION [16440]
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
NDC 0074-1940-63
|
| Hospital Charge Code |
1715199
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.25
|
| Rate for Payer: Blue Distinction Transplant |
$4.32
|
| Rate for Payer: Blue Shield of California Commercial |
$4.53
|
| Rate for Payer: Blue Shield of California EPN |
$3.52
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Media |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$4.68
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Riverside University Health System MISP |
$2.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
1755782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$203.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$79.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.65
|
| Rate for Payer: Blue Distinction Transplant |
$67.64
|
| Rate for Payer: Blue Shield of California Commercial |
$124.01
|
| Rate for Payer: Blue Shield of California EPN |
$112.74
|
| Rate for Payer: Caremore Medicare Advantage |
$79.20
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Central Health Plan Commercial |
$90.19
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.80
|
| Rate for Payer: Dignity Health Media |
$79.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$79.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$84.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$129.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$79.20
|
| Rate for Payer: InnovAge PACE Commercial |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.13
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: Prime Health Services Medicare |
$83.95
|
| Rate for Payer: Riverside University Health System MISP |
$87.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.37
|
| Rate for Payer: United Healthcare All Other HMO |
$56.37
|
| Rate for Payer: United Healthcare HMO Rider |
$56.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.12
|
| Rate for Payer: Vantage Medical Group Senior |
$79.20
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
1755659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$101.47 |
| Rate for Payer: Blue Shield of California Commercial |
$84.56
|
| Rate for Payer: Blue Shield of California EPN |
$60.20
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Central Health Plan Commercial |
$90.19
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.55
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.57
|
| Rate for Payer: United Healthcare All Other HMO |
$41.58
|
| Rate for Payer: United Healthcare HMO Rider |
$40.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.20
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
1755782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$101.47 |
| Rate for Payer: Blue Shield of California Commercial |
$84.56
|
| Rate for Payer: Blue Shield of California EPN |
$60.20
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Central Health Plan Commercial |
$90.19
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.55
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.57
|
| Rate for Payer: United Healthcare All Other HMO |
$41.58
|
| Rate for Payer: United Healthcare HMO Rider |
$40.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.20
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
1755659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$203.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$79.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.65
|
| Rate for Payer: Blue Distinction Transplant |
$67.64
|
| Rate for Payer: Blue Shield of California Commercial |
$124.01
|
| Rate for Payer: Blue Shield of California EPN |
$112.74
|
| Rate for Payer: Caremore Medicare Advantage |
$79.20
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Central Health Plan Commercial |
$90.19
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.80
|
| Rate for Payer: Dignity Health Media |
$79.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$79.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$84.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$129.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$79.20
|
| Rate for Payer: InnovAge PACE Commercial |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.13
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: Prime Health Services Medicare |
$83.95
|
| Rate for Payer: Riverside University Health System MISP |
$87.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.37
|
| Rate for Payer: United Healthcare All Other HMO |
$56.37
|
| Rate for Payer: United Healthcare HMO Rider |
$56.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.12
|
| Rate for Payer: Vantage Medical Group Senior |
$79.20
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
NDC 50242-053-06
|
| Hospital Charge Code |
1755782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$101.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.61
|
| Rate for Payer: Blue Distinction Transplant |
$67.64
|
| Rate for Payer: Blue Shield of California Commercial |
$70.91
|
| Rate for Payer: Blue Shield of California EPN |
$55.13
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Central Health Plan Commercial |
$90.19
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.83
|
| Rate for Payer: Dignity Health Media |
$95.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$84.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.55
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: Riverside University Health System MISP |
$45.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.37
|
| Rate for Payer: United Healthcare All Other HMO |
$56.37
|
| Rate for Payer: United Healthcare HMO Rider |
$56.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.83
|
| Rate for Payer: Vantage Medical Group Senior |
$95.83
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
NDC 50242-051-21
|
| Hospital Charge Code |
1755659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$101.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.61
|
| Rate for Payer: Blue Distinction Transplant |
$67.64
|
| Rate for Payer: Blue Shield of California Commercial |
$70.91
|
| Rate for Payer: Blue Shield of California EPN |
$55.13
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Central Health Plan Commercial |
$90.19
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.83
|
| Rate for Payer: Dignity Health Media |
$95.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$84.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.55
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: Riverside University Health System MISP |
$45.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.37
|
| Rate for Payer: United Healthcare All Other HMO |
$56.37
|
| Rate for Payer: United Healthcare HMO Rider |
$56.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.83
|
| Rate for Payer: Vantage Medical Group Senior |
$95.83
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
NDC 50242-053-06
|
| Hospital Charge Code |
1755782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$101.47 |
| Rate for Payer: Blue Shield of California Commercial |
$84.56
|
| Rate for Payer: Blue Shield of California EPN |
$60.20
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Central Health Plan Commercial |
$90.19
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.55
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.57
|
| Rate for Payer: United Healthcare All Other HMO |
$41.58
|
| Rate for Payer: United Healthcare HMO Rider |
$40.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.20
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
NDC 50242-051-21
|
| Hospital Charge Code |
1755659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$101.47 |
| Rate for Payer: Blue Shield of California Commercial |
$84.56
|
| Rate for Payer: Blue Shield of California EPN |
$60.20
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Central Health Plan Commercial |
$90.19
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.55
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.57
|
| Rate for Payer: United Healthcare All Other HMO |
$41.58
|
| Rate for Payer: United Healthcare HMO Rider |
$40.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.20
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
|
IP
|
$674.52
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
NDG218742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.90 |
| Max. Negotiated Rate |
$607.07 |
| Rate for Payer: Blue Shield of California Commercial |
$505.89
|
| Rate for Payer: Blue Shield of California EPN |
$360.19
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Central Health Plan Commercial |
$539.62
|
| Rate for Payer: Cigna of CA HMO |
$472.16
|
| Rate for Payer: Cigna of CA PPO |
$472.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$269.81
|
| Rate for Payer: Galaxy Health WC |
$573.34
|
| Rate for Payer: Global Benefits Group Commercial |
$404.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$449.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.90
|
| Rate for Payer: Multiplan Commercial |
$505.89
|
| Rate for Payer: Networks By Design Commercial |
$337.26
|
| Rate for Payer: Prime Health Services Commercial |
$573.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.70
|
| Rate for Payer: United Healthcare All Other HMO |
$248.76
|
| Rate for Payer: United Healthcare HMO Rider |
$243.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.59
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
|
OP
|
$674.52
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
NDG218742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$607.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.82
|
| Rate for Payer: Blue Distinction Transplant |
$404.71
|
| Rate for Payer: Blue Shield of California Commercial |
$62.01
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Caremore Medicare Advantage |
$37.40
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Central Health Plan Commercial |
$539.62
|
| Rate for Payer: Cigna of CA HMO |
$472.16
|
| Rate for Payer: Cigna of CA PPO |
$472.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.11
|
| Rate for Payer: Dignity Health Media |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.40
|
| Rate for Payer: Galaxy Health WC |
$573.34
|
| Rate for Payer: Global Benefits Group Commercial |
$404.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$505.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.40
|
| Rate for Payer: InnovAge PACE Commercial |
$56.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$449.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.12
|
| Rate for Payer: Multiplan Commercial |
$505.89
|
| Rate for Payer: Networks By Design Commercial |
$337.26
|
| Rate for Payer: Prime Health Services Commercial |
$573.34
|
| Rate for Payer: Prime Health Services Medicare |
$39.65
|
| Rate for Payer: Riverside University Health System MISP |
$41.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$404.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$404.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.26
|
| Rate for Payer: United Healthcare All Other HMO |
$337.26
|
| Rate for Payer: United Healthcare HMO Rider |
$337.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.15
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
|
OP
|
$673.08
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
NDG218821
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$605.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.82
|
| Rate for Payer: Blue Distinction Transplant |
$403.85
|
| Rate for Payer: Blue Shield of California Commercial |
$62.01
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Caremore Medicare Advantage |
$37.40
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Central Health Plan Commercial |
$538.46
|
| Rate for Payer: Cigna of CA HMO |
$471.16
|
| Rate for Payer: Cigna of CA PPO |
$471.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.11
|
| Rate for Payer: Dignity Health Media |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.40
|
| Rate for Payer: Galaxy Health WC |
$572.12
|
| Rate for Payer: Global Benefits Group Commercial |
$403.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$605.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$504.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.40
|
| Rate for Payer: InnovAge PACE Commercial |
$56.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.12
|
| Rate for Payer: Multiplan Commercial |
$504.81
|
| Rate for Payer: Networks By Design Commercial |
$336.54
|
| Rate for Payer: Prime Health Services Commercial |
$572.12
|
| Rate for Payer: Prime Health Services Medicare |
$39.65
|
| Rate for Payer: Riverside University Health System MISP |
$41.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$403.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$403.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$336.54
|
| Rate for Payer: United Healthcare All Other HMO |
$336.54
|
| Rate for Payer: United Healthcare HMO Rider |
$336.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$336.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.15
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
|
IP
|
$673.08
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
NDG218821
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.62 |
| Max. Negotiated Rate |
$605.77 |
| Rate for Payer: Blue Shield of California Commercial |
$504.81
|
| Rate for Payer: Blue Shield of California EPN |
$359.42
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Central Health Plan Commercial |
$538.46
|
| Rate for Payer: Cigna of CA HMO |
$471.16
|
| Rate for Payer: Cigna of CA PPO |
$471.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$269.23
|
| Rate for Payer: Galaxy Health WC |
$572.12
|
| Rate for Payer: Global Benefits Group Commercial |
$403.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$605.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.62
|
| Rate for Payer: Multiplan Commercial |
$504.81
|
| Rate for Payer: Networks By Design Commercial |
$336.54
|
| Rate for Payer: Prime Health Services Commercial |
$572.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.16
|
| Rate for Payer: United Healthcare All Other HMO |
$248.23
|
| Rate for Payer: United Healthcare HMO Rider |
$242.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.12
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
CPT Q5123
|
| Hospital Charge Code |
NDG229898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Blue Shield of California Commercial |
$64.52
|
| Rate for Payer: Blue Shield of California EPN |
$45.93
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Central Health Plan Commercial |
$68.82
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.41
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.48
|
| Rate for Payer: United Healthcare All Other HMO |
$31.72
|
| Rate for Payer: United Healthcare HMO Rider |
$31.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.39
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
CPT Q5123
|
| Hospital Charge Code |
NDG229898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$256.66 |
| Rate for Payer: Adventist Health Medi-Cal |
$41.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$256.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.34
|
| Rate for Payer: Blue Distinction Transplant |
$51.61
|
| Rate for Payer: Blue Shield of California Commercial |
$54.11
|
| Rate for Payer: Blue Shield of California EPN |
$42.06
|
| Rate for Payer: Caremore Medicare Advantage |
$41.42
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Central Health Plan Commercial |
$68.82
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.77
|
| Rate for Payer: Dignity Health Media |
$45.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.42
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$64.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$67.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.42
|
| Rate for Payer: InnovAge PACE Commercial |
$62.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.50
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: Prime Health Services Medicare |
$43.90
|
| Rate for Payer: Riverside University Health System MISP |
$45.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.01
|
| Rate for Payer: United Healthcare All Other HMO |
$43.01
|
| Rate for Payer: United Healthcare HMO Rider |
$43.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.56
|
| Rate for Payer: Vantage Medical Group Senior |
$45.56
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
CPT Q5119
|
| Hospital Charge Code |
NDG226878
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Blue Shield of California Commercial |
$64.52
|
| Rate for Payer: Blue Shield of California EPN |
$45.93
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Central Health Plan Commercial |
$68.82
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.41
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.48
|
| Rate for Payer: United Healthcare All Other HMO |
$31.72
|
| Rate for Payer: United Healthcare HMO Rider |
$31.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.39
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
CPT Q5119
|
| Hospital Charge Code |
NDG226878
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$155.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.34
|
| Rate for Payer: Blue Distinction Transplant |
$51.61
|
| Rate for Payer: Blue Shield of California Commercial |
$94.62
|
| Rate for Payer: Blue Shield of California EPN |
$86.02
|
| Rate for Payer: Caremore Medicare Advantage |
$20.45
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Central Health Plan Commercial |
$68.82
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.56
|
| Rate for Payer: Dignity Health Media |
$22.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.60
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.45
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$64.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.45
|
| Rate for Payer: InnovAge PACE Commercial |
$30.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: Prime Health Services Medicare |
$21.67
|
| Rate for Payer: Riverside University Health System MISP |
$22.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.01
|
| Rate for Payer: United Healthcare All Other HMO |
$43.01
|
| Rate for Payer: United Healthcare HMO Rider |
$43.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.49
|
| Rate for Payer: Vantage Medical Group Senior |
$22.49
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
CPT Q5119
|
| Hospital Charge Code |
NDG22687A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Blue Shield of California Commercial |
$64.52
|
| Rate for Payer: Blue Shield of California EPN |
$45.93
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Central Health Plan Commercial |
$68.82
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.41
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.48
|
| Rate for Payer: United Healthcare All Other HMO |
$31.72
|
| Rate for Payer: United Healthcare HMO Rider |
$31.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.39
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
CPT Q5119
|
| Hospital Charge Code |
NDG22687A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$155.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.34
|
| Rate for Payer: Blue Distinction Transplant |
$51.61
|
| Rate for Payer: Blue Shield of California Commercial |
$94.62
|
| Rate for Payer: Blue Shield of California EPN |
$86.02
|
| Rate for Payer: Caremore Medicare Advantage |
$20.45
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Central Health Plan Commercial |
$68.82
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.56
|
| Rate for Payer: Dignity Health Media |
$22.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.60
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.45
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$64.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.45
|
| Rate for Payer: InnovAge PACE Commercial |
$30.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: Prime Health Services Medicare |
$21.67
|
| Rate for Payer: Riverside University Health System MISP |
$22.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.01
|
| Rate for Payer: United Healthcare All Other HMO |
$43.01
|
| Rate for Payer: United Healthcare HMO Rider |
$43.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.49
|
| Rate for Payer: Vantage Medical Group Senior |
$22.49
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
|
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-580-30
|
| Hospital Charge Code |
1712514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.82
|
| Rate for Payer: Blue Distinction Transplant |
$13.02
|
| Rate for Payer: Blue Shield of California Commercial |
$13.65
|
| Rate for Payer: Blue Shield of California EPN |
$10.61
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Central Health Plan Commercial |
$17.36
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Media |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Riverside University Health System MISP |
$8.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
|
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-580-30
|
| Hospital Charge Code |
1712514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Blue Shield of California Commercial |
$16.28
|
| Rate for Payer: Blue Shield of California EPN |
$11.59
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Central Health Plan Commercial |
$17.36
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-578-01
|
| Hospital Charge Code |
1712515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.82
|
| Rate for Payer: Blue Distinction Transplant |
$13.02
|
| Rate for Payer: Blue Shield of California Commercial |
$13.65
|
| Rate for Payer: Blue Shield of California EPN |
$10.61
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Central Health Plan Commercial |
$17.36
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Media |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Riverside University Health System MISP |
$8.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
